Effects Of Tourniquet Application On Enhanced Recovery After Surgery(ERAS)and Ischemia-reperfusion Post-Total Knee Arthroplasty

Purpose:Pneumatic tourniquets are used in total knee arthroplasty(TKA)for surgical field visualization and improved cementation;however,their use is controversial.This study aimed to assess the effects of tourniquet application on enhanced recovery posy-TKA.Methods:A prospective randomized single-blinded trial assessed tourniquet’s effects on post-operative pain,swelling and early outcome in TKA.One-hundred patients with knee osteoarthritis were randomized to full-course(FC)and second half-course(SHC)application(n=50/group).TNF-a,CCL-2,PTX-3,PGE-2,SOD-1 and Mb were assessed by ELISA,while the VAS,ROM and thigh circumference growth rate were recorded.Results:Average tourniquet duration significantly differed between the SHC(37.5±5.1 min)and FC(66.4±7.2 min)groups(p<0.01);VAS and thigh circumference growth rate in the SHC group were much lower compared with the FC group,while ROM was higher within 48 hours of tourniquet removal(p<0.01).Blood TNF-a,PTX-3,CCL-2,PGE2,SOD-1 and Mb were lower in the SHC group than the FC group(p<0.01).Additionally,intraoperative blood loss was significantly elevated in the SHC group than the FC group(p<0.01),with lower postoperative blood loss in the drain(p=0.001).Postoperative drainage volume was reduced in the SHC group compared with the FC group(p<0.01);five and two patients in the FC and SHC groups required blood transfusion,respectively(p=0.025).Hospital stay tended to be shorter in the SHC group(p=0.023),and no tourniquet-related complications were recorded.Conclusion:Improved therapeutic outcome was observed in the SHC group,indicating patients should routinely undergo TKA with second half-course tourniquet application.